Retrospective comparison of left ventricular systolic dysfunction assessed by left ventricular global longitudinal strain in hemodialysis patients with preserved left ventricular ejection fraction and patients with hypertensive left ventricular hypertrophy
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Background Multiple factors, including hypertension, affect left ventricular remodeling in hemodialysis (HD) patients. Therefore, this retrospective study used left ventricular global longitudinal strain (GLS), an excellent method for detecting mild left ventricular systolic dysfunction, to compare left ventricular systolic function in HD patients with preserved left ventricular ejection fraction (LVEF) and patients with hypertensive left ventricular hypertrophy (HLVH). Methods Participants were aged 60 years or older and had an LVEF of 60% or higher. We compared 20 HD patients (HD group) with 20 HLVH patients matched for age and sex (HLVH group) and 20 healthy control individuals (C group). GLS decline was defined as a GLS value greater than the GLS reference value, which was the mean value of + 2×standard deviation in the C group. Results LVEF was not significantly different between the 3 groups, but GLS was significantly worse in the HD group (-15.8%±1.4%) than in the C group (-19.3%±1.1%, p < 0.01) and HLVH group (-17.0%±1.4%, p < 0.05). Relative wall thickness (RWT) and left ventricular mass index (LVMI) were significantly higher in the HLVH and HD groups than in the C group (p < 0.01), and hemoglobin (Hb) levels were significantly lower in the HD group than in the C and HLVH groups (p < 0.01). The frequency of GLS decline (i.e., GLS>-17.0%) was significantly higher in the HD group than in the HLVH group (p < 0.01). Multiple regression analysis of the 3 groups showed that increased RWT and LVMI and decreased Hb were significantly associated with GLS decline (p < 0.01). Conclusions HD patients with preserved LVEF have a significantly greater decline in GLS than HLVH patients. Increased RWT and LVMI with renal anemia may contribute to GLS decline in HD patients with LVEF.
